Basic Information
Provider Information
NPI: 1821519646
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KRAJCI
FirstName: DANIEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4432 EMMA PL NW
Address2:  
City: CANTON
State: OH
PostalCode: 447085248
CountryCode: US
TelephoneNumber: 3309049886
FaxNumber:  
Practice Location
Address1: 1320 MERCY DR NW
Address2:  
City: CANTON
State: OH
PostalCode: 447082614
CountryCode: US
TelephoneNumber: 3304891000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/01/2017
LastUpdateDate: 07/01/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001XRES.003825OHY Dental ProvidersDentistGeneral Practice

No ID Information.


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